Clostridium Difficile Colitis (cont.)

Dennis Lee, MD

Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

How are relapses of Clostridium difficile colitis treated?

An oral resin by mouth such as cholestyramine (Questran) that binds toxins and inactivates them

Non-pathogen (harmless) yeast by mouth such as Saccharomyces boulardii, for example, Florastor

Doctors usually treat patients who relapse with another 10 or 14 day course of metronidazole or vancomycin, and a majority of the patients so treated will recover. Nevertheless, some patients will have another relapse.Treatment options for multiple relapses include:

Treatment with one of the options listed above that has not already been tried.

Vancomycin for six weeks in decreasing doses (125 mg four times a day for one week, three times a day for another week, twice a day for another week and so on), followed by four weeks of cholestyramine (Questran).

Two weeks of vancomycin or metronidazole along with four weeks of S. boulardii (Florastor).

Fecal enemas from healthy relatives and family members. Feces from non-infected donors are made into a suspension and administered as enemas to the patient with multiple relapses. The normal bacteria from the donor's stool displaces the C. difficile bacteria.

Passive immunizations with human gammaglobulin. Patients with multiple relapses typically have low levels of antibodies to C. difficile toxins. By giving patients who relapse gammaglobulin containing large amounts of antibodies to C. difficile toxins, the patients' levels of antibody to C. difficile toxins are increased. Pooled human gammaglobulin can be administered intravenously.

Active vaccination for C. difficile toxins. Vaccination can increase a patient's levels of antibodies to C. difficile toxins. This is a new treatment that has not become widely available.